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Biomedical subjects

S B Benjamin

Publications and source records attributed to S B Benjamin.

103 records · Page 6Linked to original sources
PubMed1979

High amplitude, peristaltic esophageal contractions associated with chest pain and/or dysphagia.

Esophageal manometric tracings obtained using low-compliance pneumohydraulic infusion systems were reviewed from patients with symptoms of chest pain and/or dysphagia. Using this sytem, we report on 7 symptomatic patients with markedly increased esophageal peristaltic amplitude. Maximal peristaltic amplitude for these 7 patients (225-430 mmHg) was greater than for normals (75-175 mmHg). Mean peristaltic amplitude for the 7 was 170 mmHg, which was greater than for normals (81 +/- 30 mmHg, mean +/- 2 SD). This finding is believed to reflect the sensitivity of currently available manometric systems. It may be possible with these techniques to define more clearly the bulk of presumed esophageal dysfunction, which is at present poorly characterized. The relationship of clinical symptoms to abnormal esophageal motility is often less than optimal and may result from an inability to define "normal" or from inadequacies of currently available techniques. Our observations of a subset of symptomatic patients having peristaltic contractions with amplitudes exceeding the normal range seem to characterize one form of esophageal motility defect. This abnormality was seen more frequently than diffuse esophageal spasm in our laboratory.

Adult↗
PubMedDate not supplied

Phenylbutazone liver injury: a clinical-pathologic survey of 23 cases and review of the literature.

Phenylbutazone has been reported to produce several forms of hepatic injury. A clinical and histologic review of 23 well-substantiated cases in conjunction with review of 43 case reports in the literature was undertaken. Utilizing the histologic features and available clinical data, the injury was classified as moderate-marked hepatocellular injury, minor hepatocellular injury, and other injury. No sexual differences were noted. Most patients had used the drug for less than 6 weeks. Features of hypersensitivity were common. Granulomas on liver biopsy were seen mainly in association with clinical evidence of hypersensitivity nd with minor hepatocellular liver injury. The majority of deaths occurred in cases with significant hepatocellular injury or systemic vasculitis. Analysis of available data suggests that, although hypersensitivity appears to contribute to phenylbutazone-associated hepatic injury, the drug also appears to have intrinsic hepatotoxic potential. Speculation is offered regarding the relative role of these two mechanisms in the several forms of hepatic injury induced by phenylbutazone.

Adolescent↗
PubMedDate not supplied

The morphologic spectrum of halothane-induced hepatic injury: analysis of 77 cases.

Hepatic histopathology and clinical-pathologic correlations were studied in 77 patients who met clinical criteria for halothane hepatotoxicity. They were divided into groups based on the type of surgery (minor or major) and outcome (nonfatal, biopsy group or fatal, autopsy group). The two nonfatal groups (minor surgery and major surgery) and the two fatal groups (minor surgery and major surgery) were comparable with regard to age, time of onset from exposure, peak aminotransferase values and peak bilirubin determinations. A spectrum of histologic patterns was identified in these patients. It ranged from panlobular and multifocal spotty necrosis resembling viral hepatitis through submassive confluent zonal necrosis to massive necrosis. Progression of severity of injury from spotty to massive necrosis was more closely related to multiple exposures to halothane (and especially repeated exposure within less than three months), than to the extensiveness of the associated surgical procedures.

Adult↗
PubMedDate not supplied

Small bowel obstruction and the Garren-Edwards gastric bubble: an iatrogenic bezoar.

Subsequent to its introduction as an adjunct to diet and behavioral modification in the management of exogenous obesity, the major complication of the Garren-Edwards gastric bubble (GEB) was small bowel obstruction (SBO) due to balloon deflation and obstruction in the jejunum or ileum. Seventy-two cases of patients with SBO due to the GEB requiring surgery and 15 cases of patients with SBO treated medically were reviewed in an attempt to determine risk factors predicting obstruction and to evaluate for treatment methods that might avoid the need for surgery. In these patients a deflated GEB behaved as a typical blunt foreign body. If the device is found to be in the small bowel and fails to pass or move and is associated with fever, leukocytosis, or complete SBO, surgery is required since the bowel may become ischemic, predicting the same high risk outcome seen with other blunt foreign bodies. With the introduction of other similar devices in the near future, since these devices behave as blunt foreign bodies, it cannot be assumed that they will pass uneventfully and appropriate evaluation and therapy must be initiated.

Adult↗
PubMedDate not supplied

Utility of upper endoscopy in the evaluation of noncardiac chest pain.

The diagnostic yield of esophagogastroduodenoscopy, esophageal manometry, and Bernstein testing was assessed in 100 consecutive patients being evaluated for non-cardiac chest pain. Manometric studies revealed the nutcracker esophagus in 21 patients; non-specific esophageal motility disorders in 19 patients; a hypertensive lower esophageal sphincter in 4 patients; diffuse esophageal spasm in 2 patients; and normal motility in 54 patients. Endoscopy was normal in 38 patients; but revealed grades II to IV esophagitis in 24 patients; gastritis and/or duodenitis in 18 patients; a sliding hiatal hernia without evidence of esophagitis in 14 patients; and gastric or duodenal ulcers in 6 patients. Twenty-five individuals were found to have normal manometric studies in combination with a negative Bernstein test. Among these 25 patients, however, 7 patients had esophagitis (grade II or higher); 6 patients had gastritis and/or duodenitis; five patients had a sliding hiatal hernia without esophagitis; 1 patient had peptic ulcer disease; and only 6 patients had a normal endoscopic exam. Our results indicate that endoscopy can identify a significant number of patients with acid-peptic disease who present with non-cardiac chest pain, that would not have been otherwise diagnosed by esophageal manometry or Bernstein testing alone or in combination.

Chest Pain↗
PubMedDate not supplied

Limited benefit of atropine as premedication for colonoscopy.

A prospective double-blind trial was performed comparing atropine (0.5 mg) by slow intravenous administration to placebo as premedication for colonoscopy, to assess the possible beneficial effects of this vagolytic agent on the performance and safety of the procedure. A total of 77 patients was randomly assigned to receive atropine (38 patients) or placebo (39 patients) before colonoscopy in conjunction with our standard initial medications for conscious sedation (meperidine, 0.4 mg/kg and midazolam, 0.03 mg/kg). Total procedure time was 31 min for the atropine group and 35 min for the placebo group (p greater than 0.05), and there was no overall difference in the total amount of intra-procedural medications required. No statistically significant differences were observed relative to the number or severity of vagal episodes, and neither the endoscopist nor the patients noted any differences in the ease or tolerance of the procedure (p greater than 0.05). Although these results fail to demonstrate a significant benefit of atropine when given routinely as premedication for colonoscopy, this study does not rule out the potential usefulness of atropine in counteracting vagal episodes when they occur.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy.

We used data from the American Society for Gastrointestinal Endoscopy's computer-based management system to compare the rates of serious cardiorespiratory complications and death associated with the use of midazolam and diazepam. Data were analyzed from 21,011 procedures. Midazolam was used in 15,061 of these procedures, diazepam in 4,302, and neither in 1,648. We assessed benzodiazepine dose, concomitant drug administration, type of procedure, and selected patient characteristics in each of these three groups. No significant difference between these three groups were noted other than the fact that certain clinical centers tended to exclusively use midazolam, whereas others used both benzodiazepines. Reports of serious cardiorespiratory complications and death were uncommon, occurring in 5.4 and 0.3 per thousand procedures, respectively. Midazolam did not seem to place patients in this sample at greater risk for cardiorespiratory complications than diazepam. Concomitant use of narcotics and urgent and emergent procedures, however, did increase the risk of serious cardiorespiratory events.

Aged↗
PubMedDate not supplied

Diazepam versus midazolam for colonoscopy: a prospective evaluation of predicted versus actual dosing requirements.

We performed a prospective, randomized, double-blind study to evaluate the efficacy of the currently recommended low doses of midazolam for conscious sedation compared with diazepam for colonoscopy. Each agent was administered in a fixed ratio dose in combination with meperidine, and titrated incrementally to allow for adequate sedation prior to initiating and during the procedure. The currently recommended starting dose of midazolam (0.03 mg/kg) proved to be very appropriate for pre-medication. In contrast, the currently recommended starting dose of diazepam (0.10 mg/kg) proved excessive in 21% of patients (especially in those aged > 65). The low initial and incremental doses of midazolam compared favorably with diazepam in all efficacy parameters studied and exceeded diazepam in post-procedure amnesia scores (p = 0.01). Moreover, the sedative effects of midazolam at these lower doses were not lost despite long duration procedures (> 40 min). We conclude that midazolam, given in small incremental doses, in combination with meperidine, produces effective conscious sedation for colonoscopy and exceeds diazepam in its amnestic effect.

Adult↗